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SMME #440 Legal Clarity on GLP-1s in Medically Assisted Weight Loss with Courtney Walker
00:50:12
Legal Clarity on GLP-1s in Medically Assisted Weight Loss with Courtney Walker
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- [00:00]
Daniela
Hey, Daniela here and I have some insider information for you. After six months of refining, refreshing and seriously upgrading our signature growth factor framework, we're reopening the doors this October. This isn't just a program, it's a game changing experience designed to help you build predictable revenue, get out of the treatment room and lead with confidence. If you've been dreaming of true freedom and financial growth in your spa, now is the time to take action. Head over to attoesthetics.com join the wait list. We will absolutely have some exclusive bonuses just for those on the wait list. Hey, Daniella here and welcome to the Spa Marketing Made Easy podcast. If you offer medically assisted weight loss in your practice, first, what a wild year it's been. And second, I am so glad you're here because my friend Courtney is going to shed so much light on this topic from a legal perspective. There's so much incredible information in this episode. I really just want to jump right in. So I'm going to read Courtney's bio. I know you'll love her as much as I do and I truly hope that this episode helps you. So Courtney is a corporate attorney turned medical aesthetics insider who knows the industry from both sides of the syringe. After serving as founder and legal architect of a fast growing aesthetics company, she made the pivot from building her own to helping other providers build theirs, minus the legal landmines. Now, as the founder of Court Approved Aesthetics, she brings attorney trained tools, AI innovation and hard earned insight into the med spa world. She's here to share what she's learned, sometimes the hard way, so that you can grow with confidence, clarity and a whole lot fewer compliance headaches. She's incredible. And again, I hope this episode helps you. All right, Ms. Courtney, welcome to the Spa Marketing Made Easy podcast. I'm so, so excited to have you here. And you are someone that I categorize as a fast friend because when we first we it was. Was it Paulina or Jacqueline?
- [02:22]
Courtney
Yeah, Paulina.
- [02:23]
Daniela
Okay, so Jacqueline introduced me to Paulina. Paulina introduced me to you in the web of our small industry and we got on the phone and talked about Dolly Parton and our kids for 25 minutes and then had to go, yeah.
- [02:38]
Courtney
And I so funny. It's like one of my most favorite meetings and I love when meetings go that way because my husband at the end was like, how did it go? I'm like, how'd the business meeting go? I'm not sure. I didn't attend a business meeting, but my really great friend Daniela. That I've known for years, that I just met, and that. That, that's like my most favorite meetings because, you know, I think so quickly in the industry and as an attorney, people come into this with a lot of expectations. And so one of the biggest compliments that I've. I received a few times is that someone. I'm. Someone you feel like you've known for years. Like, that's amazing because that's a lot of, you know, perceptions and expectations that are just broken down because I think people number one. Or when someone tells me I'm fun, because attorneys are not fun and they're not personable. So.
- [03:30]
Daniela
So I'm married and engineers kind of have their own category as well that, like, attorneys have. And I fully agree that, like, I wouldn't look at you and just peg you as an attorney, but you're also. You're different. Like, you're a spot owner. You're a. A business owner. You're like, there's all of these things. An attorney is just a small piece of you as a whole. And so, yes, I'm sure that you can get into that very analytical mode and you can get into that space, but there's more to you than that one little thing.
- [04:12]
Courtney
Yeah, I completely agree. One of the things I say pretty often is that compliance is great, but compliance actually lives in your operations. So I can spout the law and tell you what it is all day long, but it still leaves you the question of like, okay, now what? So wearing those hats and knowing, you know, what, in the. In the trenches of being a business owner and a med spot owner of what does this actually look like? Okay, here's the statute, here's the reg, here's the flowchart. Now let's put on our business owner hat and be like, how do we make this make sense and make it not have a million different, you know, gates and funnels and we don't have team burnout. And it's. That's my favorite part of the job is taking, like, the legal, but then putting it into action and putting it into a way that actually makes sense and doesn't cause a burnout and leads to, like, more profit in businesses.
- [05:06]
Daniela
So talking about how to make this make sense, that really leads us into our topic today. Very well. We're talking about GLPs and what the heck is going on with them. There's, you know, there has been this massive growth over the past couple of years where we've seen practices, you know, attract a whole new demographic of patients. We've seen phenomenal results. We've seen just increased profit margins. It's like a win, win, win, win, win across all boards. And we started this year in our community talking about medically assisted weight loss and GLPs and how we're, you know, if you're not on that bandwagon, then get in that bandwagon because it's, it's the thing right now, and it's profit and, and all of the things. And then we had tirzepatide taken off the shortage list. We had semaglutide taken off the shortage list. And there's practices that are getting cease and desist letters. Nobody knows what to do. And so many people in our industry, or at least in our community, we're rule followers, we're people pleasers. Where, you know, there's these kind of. We're, we're recovering people pleasers, I'll say. And we want to make sure that we have everything lined up in a row. But it's, it's scary and hard to understand what is the right thing to do. And so when you suggested this as a topic, I thought, okay, I am not an attorney. I'm not going anywhere near that conversation. Like, I know, you know, it's like, that is out of my scope. And let's bring somebody in that, you know, you're in it. You're. You have a med spa, you are an attorney. So let's. You teach compliance to other med spas. So I want to hear your perspective. Where is the place that we should start with this?
- [07:15]
Courtney
Yeah. So I did an hour and a half master class on this topic. So anytime someone asks me to speak on it, I'm like, let me condense down an hour and a half masterclass. Because one of the things that I am so passionate about is I want anyone who works with me, who listens to me, who gives me the time of day to walk away and to be more informed than 90% of the rest of the people in the industry until they can convince the 90% to come, you know, get the same lecture. Because I could give you the quick and easy answer, like three lines, here's the answer for your problem, but then you don't know the why. You don't have any type of protection or reassurance. And what I found is people want the answers, but what they actually want is, like, put their head on their pillow at night to feel confident in the answer. And I had a meeting with a new potential client a couple weeks ago, and the meeting started with, I've asked this question to two different attorneys and I've received two different answers. And I was like, well, I might give you a third answer, but I'm going to give you the backstory first, which a lot of people in the legal world, when you're hiring an attorney, you don't want to pay someone $500 an hour to spend an hour and a half talking about this topic to help you understand the answer. But in my opinion, it's almost as important as a business owner to get that back information than the answer itself. So I really like to start with like, how did we get here so we can get our arms around the whole topic. So one of the things I hear pretty often in the world of GLP1s is, well, we were able to compound these before. And so that's, you know, the first thing that, especially in the masterclass that we walked through was, yes, this is the normal trajectory. So compounded drugs are, are then picked up by pharmacies. And we pharmacies or manufacturers, and manufacturers pour boat loads of money into getting them FDA approved. And then they are given a patent, they're giving, given trademarks over their name and the, the, you know, the image and the, they have a trademark on the actual, like syring that's used. And that is what pulls them from being able to be compounded. But absolutely, these medications were. You were able to compound them prior to a big company picking them up, pouring boatloads of money into it.
- [09:38]
Daniela
So I've heard people say, well, they're adding B12 or they're adding, you know, something else that, that modifies it some percentage, and so they feel that it should be something that's reasonably different. Is that true or is that not true?
- [09:56]
Courtney
Yeah, it's the material copy argument. So now that we, you know, the, the drugs went on the shortage list, then they came shortage. Going on the shortage list allows compounders to compound it. Everyone knows they came off of it. And now we are in this. Okay, we know we cannot make the identical copy, which we were allowed to while they're on the shortage list, but what can we make? And I say we as in the compounding pharmacies. So if we could draw a chart. You have Eli Lilly, Novo Nordisk up at the, you know, at the top of this chart. The FDA is underneath them and then the compounding pharmacies. And I have a chart that kind of depicts this. There's no line that connects Novo Nordisk to the compounding pharmacies. You have to go through the fda. And there's actually a case on this in Florida where essentially Novo Nordisk sued. It might have been Eli Lilly, one of the two, sued a compounding pharmacy. And the court essentially says, like, sit down. Not your job. That's the FDA's job to regulate compounding pharmacies. So what a compounding pharmacy now is trying to get around is that they are not making a material copy of this medication. So they are saying adding B12 or B6 or glycine is another one. It takes it out of the material copy requirement that the FDA has. Ultimately, what I tell my clients who are practitioners is not really your problem unless you're compounding because you're not making any material copy. So when we get to practitioners, the other side of that chart is at the top. You have your governing body, whoever it is, your board of medicine, your board of nursing, your board of cosmetology providers. That's who oversees providers. But again, there's no connection between compounding pharmacies to the providers other than ordering. There's no connection from Eli Lilly to the providers. We providers are responsible to their boards. That's who oversees their license. And I spend a lot of time on this topic because one of the things I hear and I've heard is that, well, what if we just don't call them patient? What if we call them clients? And instead of giving acts, instead of giving prescription medication, we're giving access to material that can, you know, insert whatever over the counter.
- [12:26]
Daniela
Yeah, yeah.
- [12:27]
Courtney
Like, it's not. I'm like, no, I want you to lean in as heavy as you can, and I will stand in front of you as we say this, that this is the practice of medicine. We are prescribing medications to treat patients for various reasons, and we are using our medical judgment to create those prescriptions. So we believe that someone needs this version of medication with B6 for the following reasons. We need. We believe someone needs this version with b12 for the following medical reasons, because I do not have any say in the practice of medicine, because that is not within the scope of my license. Novo Nordisk, Eli Lilly, have no say in the practice of medicine that is not within the scope of their license. So they cannot come in and tell you what you can and cannot prescribe to your patients. That is up to the board of medicine or the board of nursing or whatever board you are responsible to. So one of the things, again, I spend a lot of time on this exact slide to say at the end of the day, what we're talking about is your liability is good old fashioned negligence. Like are you treating patients the way that you believe they need to be treated?
- [13:40]
Daniela
Let me, let me give an example and you can explain because you mentioned in the beginning some of these drugs are covered by patents or trademarks. And if I'm a spa, like my company, Auto Aesthetics is trademarked. So if somebody else brought that, use that name, I could send them a cease and desist letter. Is it not parallel that Eli Lilly or those other, any of these other companies that own these patents or trademarks, can't they come after a spa using that? If so, they, they wouldn't be able to use the name Ozempic or Moreno or anything like that. But if you use the name Semaglutide or is that the generic like that's generic enough that we can use Semaglutide or Tirzepatide. And so as long as we're only using those names, that's not what the trademark is protecting.
- [14:44]
Courtney
Correct?
- [14:44]
Daniela
Correct.
- [14:45]
Courtney
Yeah. So, yeah. So the trademark that, so they have a patent over the formula and the argument for like the formulation that is if you can, you know, divide in that, that kind of flowchart that is on the side with Eli Lilly Novo Nordisk, FDA compounding pharmacies, that is where the patent lives. Now you can have some connection between the practice, the provider and these manufacturers. Lie Lilly, Novo Nordisk if you are fringing on their trademark and that's one of the things I tell everyone is there's nothing I can do to help you on that. And they have absolutely filed lawsuits for people saying we prescribe Semaglutide AKA Ozempic or we, we prescribe the FDA approved version of Semaglutide. No you don't. You prescribe the compounded version of Semaglutide. The FDA approved version of Semaglutide is a zempic. And so they are saying then you're infringing on their actual trademarked what they've put in all them and the, the money into. And actually there's a case that was just filed within the past month in California where they are arguing it's against Mochi Health and Mochi Health's various entities where on their website they advertise that they offer the compounded version and that they offer the, the FDA approved version, the, the Semaglutide, the Ozempic. But what they actually discovered whenever they were doing or it's their belief is that that kind of was like a Bait and switch situation where you put it on your website. Sure, it's an offering that you offer, but you never ever prescribe the actual FDA approved version. You always prescribe the compounded version. And so you were just kind of riding in on the coattails of all this money and research put into these trademarked, easily recognizable names. But then the moment you got a patient in the door, you switched them to the compounded version really quickly. And so they've, that lawsuit is not over that they prescribed a compounded version. It's that you used our trademark to draw in traffic. And then we didn't benefit from it at all. So like if you're going to, if you're going to use anything recognizable to us that we own, we have to benefit from it in some way in the trademark, in the trademark world. So I tell people like that's, that's the same case for auto aesthetics. Ford Motor Company. This is not, this is not new to the practice of medicine. If the company has something that they've invested a lot of money in and they protect it, whether that be Nike, let's do it. You can't just put slip let's do it on everything those, because it has such brand recognition and that they seek to protect it. And so yeah, you will get a cease and assist if you are probably a lawsuit. I know quite a few people who have gotten a lawsuit. One here in Tennessee because they were using the AKA Semaglutide, AKA Ozempic in their marketing.
- [17:41]
Daniela
Can we say medically assisted weight loss?
- [17:43]
Courtney
Yes.
- [17:44]
Daniela
Okay, so what happens if you get a cease and desist letter?
- [17:50]
Courtney
So I've looked at a few and what I help practices do is decide is this worth it to you? I cannot do anything, literally nothing to protect someone from getting sued. And I tell you, this is my job. I have a license to be skeptical. It's what they put on your diploma that's hanging behind my license to be skeptical and cynical. If you have something related to your spa on the back of your car, I would be wary of every single person who drives next to you on the interstate and slams on the brakes too hard in front of you because they might assume that you're a business owner who has lots of money. So there's nothing I can do to protect you from getting sued. But what we can talk about is what ultimately your liability would be. And then in that. So we have, you know, the liability is the legal piece, but from the, the, the timeline of being sued to liability in that is a huge business Judgment. So I have clients who, it's only 10% of their practice. Medically assisted weight loss or any type of weight loss program where these drugs would be involved is such a small portion of their practice. Like is that business judgment of hiring an attorney to respond to a lawsuit or hiring an attorney to do something, is that worth it to you? And I have many who have said no, we really didn't even have like a full program. This isn't even our passion. We're really passionate about more, you know, skincare and longevity type health. And we can just pivot our business model. But then I have some that it is 80 to 90% of their practice. And so yes, that business, that business judgment decision lives between the lawsuit being filed and liability. So and that's I think the biggest piece that practices have to decide at the end of the day. Because if you're just prescribing the medications, you're falling within your scope of your license. I'm not really concerned. I've reviewed the demand letters, the demand letter argument, they have four points and I have, I think it's nice, nice video discussing this. But the argument they make for medical practices is so outlandish where they're trying. I mean, it's a far reaching argument. And so I'm not overly concerned with providers just prescribing the medication within the scope of their license. And if they feel confident standing in front of the board of their peers, the board of nursing, the board of medicine, and defending the way that they medically treated a patient, which they should every single time they medically treat a patient, then I'm not super concerned by them. Now they probably will get a letter. So you have to decide what to do. I have a lot of clients who are sending, have hired an attorney to send back a letter that essentially says, this is the practice of medicine. We are acting within the scope of our license. We are getting drugs from one of the sources that we are allowed to, which is a 503A pharmacy under the FDA as a provider. So you know, we're not getting drugs from overseas or we're not getting drugs from not vetted sources. We're getting them from a state licensed facility, a pharmacy, and that we are acting within our scope and prescribing them according to our clinical judgment. Now the pharmacy holds a different bag of liability because they hold the identical copy bag of liability. The practice owner itself owns a lot of the liabilities around like marketing. So how we're making sure that you.
- [21:28]
Daniela
Aren'T inferring using the correct terms and language.
- [21:32]
Courtney
Yes. Yeah. So you practice owner liability is about scope and making sure that they're treating patients according to, according to what is a reasonable judgment in medicine and the marketing piece of it and making sure that you're not infringing on any trademarks. And then the compounding pharmacy holds the patent liability.
- [21:51]
Daniela
So do you think the next phase that we're going to see if this is like a long term strategy with these pharmaceutical companies that have invested so much money they're kind of, you know, getting rid of some of the fringe by just scaring people with the cease and desist letters is the next strategy step for them actually going after the compounding pharmacies and. Okay.
- [22:20]
Courtney
And so I think the next strategy is going to be they haven't had a ton of success in going after the compounding pharmacies. Like I said in that case in Florida, the judge was like, this is the FDA's job. So what I've seen for NextStrategy so far is that they compounding pharmacies are putting pressure on the FDA to protect its patent and to be truly transparent. I feel really conflicted because I am a mom of three children and I want my children to grow up in a world where we are continuing to advance medicine and that is why we have patents, that's why we protect people for their investments. So I definitely see it. I also see the tremendous benefits to patients themselves. I just met with a client who is prescribing very, very small doses to one of her patients who has atypical bulimia. And it is now helping. They're using it in conjunction with some therapy, but it's helped kind of quieten some of the, the issues that manifest in a more physical way so they can deal with the issues that are more internal. And I mean that's real people, real problems, real medication helping out. So I see it from both sides and I really do understand where kind of practice owner is coming from, even just strictly on a clinical side. But then on a, I see it on Eli Lilly's and Novo Nordisk side too. But what I've seen so far is pushing, putting pressure on the FDA to go after compounding pharmacies. And the newest is that now these manufacturers are sending letters to state boards because again, the state board is who the provider is responsible to. So if the state board says it is not okay in this date to prescribe these compounded medications for these reasons, well, now the provider has direct guidance that says I can no longer prescribe these medications.
- [24:23]
Daniela
So would that be because they're considered, they're using them off label, or is it something that they're trying to do within scope, like only MDs are able to do this? Or because, like, how could they say that if another MD could prescribe it and get it from their pharmaceutical company? Right.
- [24:46]
Courtney
Yeah. So the letter to. Is actually a letter to the Georgia board that was sent by. I can't. I think it was Eli Lilly, but it might have been Novo Nordisk. But they're both making. Both companies are making the same argument that compounded drugs are not safe. So you should not allow. Even though we prescribe. Not we, but providers prescribe compounded drugs for all types of cases. But we should not allow compounded drugs in this specific instance or you should not across your state. You should essentially say, if you prescribe a compounded drug and one of your patients gets hurt, it's considered like de facto negligence, according to the board. And so they're trying to put pressure and they've. In their letter, they've outlined that they do have a patent and they've outlined the history, but really leaning into these medications aren't safe for patients. That's the stance. That's how they're trying to appeal to the board. And I explained it to some people that I work with. I try to use, you know, as many examples as I can that are totally outside, out of left field, but to make it make sense. So, like I said, I have three children. And so what I. I said, it's the equivalent of I would be the board in this case, as their mother. And we all know children love to tattle on each other. And so one of my children is acting like the manufacturer and, and they are tattling on not just one of them, but they're like, look at those compounding pharmacies. Look at that. Mom, did you see them? The compounding pharmacy and the provider, and they're teaming up together and they're causing all kind of mischief. You should do something about it, Mom. And so now as the board, the mother in the situation, I have to figure out what I want to respond back to my child that's tattling because they have no oversight over the other two. You know, they're not the parent. And then the two children who are acting independently, but allegedly they're, they're, you know, colluding together. What I want to do about, you know, that. And that's where the board is at at this point. We've had a few Boards, Washington, there's one in the south Mississippi, I believe, who have said no more compounded semaglutide or tirzeposide within our state. So I think that's the next kind of route that the manufacturers are going to go, try to appeal to the boards.
- [27:13]
Daniela
And then do you, I know this is very speculative, but do you believe that these manufacturers are going to try and sell their FDA approved the Ozempic or Merino or whatever directly to med spas or are they going to go directly to patients? Because what I've seen is that they're selling directly to patients at the same price that they would be selling to medical spas. But there's pharmacies. I personally know people that have bought Ozempic or these actual name brand drugs online without having to have a good faith exam, without like maybe it was a bad website. I don't know. I don't know all of the details there. But like, how are people getting it online without having medical oversight in any way? That seems like a whole other can of worms. That's like what's happening here.
- [28:24]
Courtney
Yeah, I mean, and that's one of the things I talk about pretty often is this is why we can't have nice things, because we've got people who are going off into left fields. Like we're not talking about the provider who either sees their patients in person every single appointment or they see their patient in person once and then they see them again, you know, in six months, but they have some checkups in between. We're not really talking about people who are doing it objectively the right way and that we've seen it in other areas like we've seen it in other types of management for even something as simple. As simple as, you know, acne treatment, where you go in and you get an assessment and then you're prescribed some antibiotics. Let's see how it works for you. And then we'll take down your. If you had any symptoms, have you had any improvement, and then we'll pivot your treatment plan. People who are doing it kind of in that, the fashion that we're all used to in medicine, we're not really talking about them, but what's going to happen is what always happens is that, and I like to use the word always, but in the legal world it is what always happens is we kind of have this over correction where we are actually targeting the people who are doing things wildly inappropriate and wrong. Yes. Mochi Health is one example of that. Doing things wildly incorrect and then People who are doing it actually. Okay. And it, they end up getting caught up in the storm for all of it. So I, I don't know the specific website. I know of a few where you have a medical director who's licensed in all 50 states and they have one mid level and the mid level is doing a good faith exam, not in real time. And then it's getting shipped straight to their door. I mean, I will just tell you I come from a place of being a business owner and an attorney. And so I understand that operationally we are. So we're in the business of risk. Business is risk. And if you want to know risk, I would tell you to shut down your business because that's just where we're at. And so you have to make like a risk assessment and risk tolerance in each one of these decisions. Which, that's where I was saying, you know, between liability and the lawsuit, there's a lot of business judgment that exists in there. And you have to really weigh the risk associated to your business. Is it worth it for you? Not from a liability standpoint, but just from like having to hire an attorney. But I will. All the clients that I work with, there's, I don't, we don't really risk. I don't allow a lot of like risk of compliance. So what I've seen from the way those websites work is we're not operating compliantly. We're operating only using our business hat. And legal and compliance lives in your operations. It has to, you can wear them each at once or both simultaneously. But you don't get to just throw one away and feel like we're making as much money as we possibly can out of this. Because that's when we've taken the medicine out of the corporate practice in medicine and we're just operating as a corporation. Like we're selling widgets. And you know, even me, someone who's not a provider, I'm. My clients don't go down that route. You don't have to. You can be a very, very profitable, very successful med spa and be totally compliant. And like I've seen it happen over and over and over again and you'll be standing at the end.
- [32:01]
Daniela
So what do you think when you're talking with your practices that it's, you know, 60% plus of their revenue is medically assisted weight loss. And they are doing this, you know, having them come in weekly for weigh ins and having the check ins and they're doing it with a lot of care and intention. What advice are you giving to them. Is this something that, you know, in the next five years you think is going to dwindle out because of all of this? Should they be transitioning into hrt? Should that, you know, like, what is the. I know it's all risk, but, gosh, there's some places that are doing multiple seven figures, just.
- [32:49]
Courtney
Yeah, yeah, actually, I. I know. So a favorite thing for an attorney to say is it depends. And really in this world, in the GLP1 world, I really don't feel it depends. I really feel so sure in the way to do that. There is a way with a couple of options. Once you go down that single path, there is a way to do it that is compliant for now and that we can. If your state board decides to change their opinion, then of course we need to shift. We need to pivot some, some portion of your industry, some portion of your business to have another offering to your clients and be ready to pivot should they. Should you need to. But one of the biggest things that I have to help clients overcome is, is their mindset around GLP1 medication. So what. What I saw and what I, what I've seen for the past few months is that people were charging. It's the perception that they were up charging medication when all actuality they were not. They were just not sending an itemized bill. So if you tell me that you have a patient come into your office every single week. Let's just take that for example. If I was in a, an actual office, well, my insurance copay is $40. So I would have a $40 charge every single week when I came into that office. So $160 of your upcharge. Take that off. Okay, now take the cost of the medication off. What are you left with? $20 you made on it. At the end of the day, that is not an upcharge. That is having, you know, covering the staff who injected. That's covering the alcohol swab like that is totally administrative fee. I'm not sure that you, at the end of the day, like made a ton of money on that procedure. But, but because we were doing. What I have witnessed is it was just one single charge. We were doing double the cost of the medication. That the practice owners believe that they were truly making so much money on the medication. It's like, yes, but what you haven't put into that whole equation is you. Nothing about you. And let's break that down and add all of your value into it, because whether you want to place a dollar on it, or not, I will force you to place a dollar on it, put my arm around you and make you say that like a minimum. Any, any practice I walk into, it's a $40 slap every single time. So do not tell me that you're worth less than that and that's the negotiated insurance rate. And don't tell me that you can't justify that. So what I help practice owners do is separate the two out. What is your medical advice, your medical program worth? What value do you bring to patients? Do you have nutrition help? Are you running their labs? Are their labs included? Are you doing follow ups? Are you offering other services in addition to it, like helping with volume loss? And you're giving them like a full patient assessment? How often are they coming in? Let's put all of that down on paper. And then you have the medication over here to the side, like charge them what they would be charged for the medication. Sure. But what does it cost to be a patient of yours? What is it? What is your experience that you bring that's so different from everyone else? Because I can go spa to spa and get the 503, a compounded version of semaglutide, but I cannot go spa to spa and get you. So what is that worth? And that conversation makes people very uncomfortable because they're like, well, no, they don't need to pay for me. I'm like, you are? You are. It's.
- [36:29]
Daniela
So if we take that concept into med spas or cash basis, and that's why so many providers move from medical into cosmetic and go into, and I say medical and cosmetic in the term. When I used to work at plastic surgeons offices or derm offices, there was the medical side where we did skin cancers and skin checks and those things. And the cosmetic side is what we kind of overall look at as medical aesthetics. Right. So we build completely different on the medical side, just like you were saying. But on the cosmetic side, wouldn't things like Latisse, that used to be a glaucoma medication, or even the neuromodulators that we're using that had a medical purpose, whether that was for migraines or incontinence or hyperhidrosis or any of these types of things, wouldn't we then to have to bill in a completely separate way?
- [37:35]
Courtney
So in this business, legal hat. So if I'm putting on a legal hat, then we should be. Yet the answer is yes. The difference between the business and legal hat for me is we're talking about Latisse and you're talking about Botox, which is historically billed by the unit somewhere between 10 to 15 dollars. And we aren't separating out those charges. We also don't have the pressure from need knowing that we might have to prove ourselves out at some point. So I think that additional level of detail and having them truly separated and itemizing that for transparency for patients is really brought on by the pressure of the industry and the pressure from these manufacturers. And so that's where I think you can get into wearing both hats.
- [38:28]
Daniela
It's kind of like a CYA type of thing.
- [38:30]
Courtney
Yeah. Like for Botox, the industry is 10 to 15 units or 10 to 15 per unit is pretty standard from what I've seen. And you don't have the same need to CYA when it comes to. Okay, here's what I chart. How, how people reflect their additional experience for Botox is they just up their unit charge, but not, not necessarily the same need to go into detail on the invoice for transparency for patients. Because you don't have the same like outside pressure in this world. I would absolutely. Like in the GLP1 world, I think you have to CYA in your charting. You have to see why at every single step where I'm like, okay, imagine this. We're in front of your board, I'm representing you and we are proving out that you provided excellent patient care to this individual. What would you need? You need good charting, you need good consents, good transparency in your pricing to show that you are not profiting from pushing them to one medication versus another. Like I have practices that I work with that prescribe both medications compounded and the ones covered by insurance. But the cost to work with you should be the same regardless. And that's, I don't think that you, you know, 10 years from now we won't be doing that because we won't have this outside pressure. In the world of medical esthetics, you know, in cash based businesses, we'll still be doing it in insurance billing based businesses. That's because it comes with all the federal regulations.
- [40:04]
Daniela
What do you think about hormone replacement therapy? Because it's. That kind of goes hand in hand with medically assisted weight loss. We're seeing a lot of people coupling those two. Do you feel like there will be any pressure on because there's a few main companies in that as well and there's also compounded right. In the way that people are helping. So is that if we're trying to be kind of future oriented and how can we be less risk averse or be, be less, have less risk in our business without closing it, Are those things that we need to be looking forward or is this just very specifically a GLP issue because of the shortage list type of thing?
- [40:54]
Courtney
I think this issue specifically is more related to the GLP1 problem because you've got such big players who are protecting their patents what it seems at all costs they're coming at it from every single angle. From the hormone replacement side. What I, I think the biggest risks on that is more often than not it introduces a controlled substance because testosterone is a controlled substance. So making sure that you are a practice that's compliant in how they see their patients, who's seeing their patients and then I think the risk, you know, on the spectrum of things that we offer in med spas with like you know, a facial being the lowest level of risk, it's a controlled substance for various reasons, but it does come with some additional risk to patients. So what I've, the biggest thing that I've seen for providers is that they are taking some one day course on hormone replacement therapy and thinking that they've got it on lock. And you're like, you have to defend that you prescribed the right concoction to this patient based on their blood work and like, do you feel confident in your skills and ability? So I, I've seen some kind of concerns from that area and I've heard concerns from nurse practitioners who, their practices have asked them to just roll out hormones and they're like, I don't, I don't feel comfortable because I am a, I am in the med spa space, I am not in the functional wellness space. I, I'm not treating people who have Hashimoto's. Like that is not something I'm comfortable with within my license. And that as a business owner, you know, as a non licensed business owner practitioner, I have to be really respectful. Like if one of my providers that works with my company says that that's within their scope to say I don't feel comfortable, I need additional education or additional training to be able to treat patients. Because what they're essentially saying to me is I don't feel, if you ask me, is this the right treatment, I don't really know. I don't have any clinical reason to back it up because I'm not educated on it enough. So that's the biggest risk I see for HRT is we're really getting into functional wellness and making sure that our providers are comfortable with functional wellness. Especially if you're going from strict Cosmetic and they do filler and Botox. Now you're talking about like real internal stuff. And that is a very different business model which requires training from the top down. Whoever's, you know, your medical director, your nurse practitioner, your rn, whoever is helping in that, that field, it's a new service offering.
- [43:40]
Daniela
Anything else that I'm not asking about GLPs that are GLP ones that people that you found in your research and trainings that you've been working on?
- [43:52]
Courtney
Yeah, I think the biggest, the thing that's been discussed pretty recently goes back to, okay, so now when I finish the talk and someone feels comfortable or they don't, you know, they make that business choice. Okay. One way or the other. Okay, so now they make the choice that we're going to continue. Now where can I get it from? So we know we cannot get it from a 503B pharmacy. They are, it is very clear that 503B pharmacies can, cannot produce that. And that's the pharmacy that produces like in office used big vials. They have it on the shelf. You call them up and you order 12 cannot do that anymore. But what we can DO is a 503A pharmacy can make a patient specific medication. So if you call up a 503A and say I need to order medication for Courtney Walker, like, oh yeah, we already have one ready. No, that's impossible because you're supposed to make it for Courtney Walker. So where can we get it from? I think is a huge issue. How do we vet a pharmacy? How do we make sure it's reputable? I go to their website and they have not an about. They don't have an about me section. It just started yesterday. And you can't order, you can only order over the phone and they don't send you any type of email confirmation. Seems pretty sketchy to me. So vetting the pharmacies and knowing that you where you can get it from is far as like pharmacy versus. I have a lot of questions about research based labs where you get these not just, not just GLP1s, but you get other peptides. And it comes to you in your office and it says not for human use. Can you use that on humans? And I'm like, no, no you cannot. The FDA is pretty clear as a provider where you can get medications from for human use and for peptides, which includes GLP1. So you need to stick to 503 A pharmacies and steer away from research based labs1 because you're not allowed to get them there according to the fda. But to tell me this argument, like, think forward. You're standing in front of the board of medicine and you're defending a negligence.
- [46:00]
Daniela
Something that says not for human on.
- [46:03]
Courtney
Why you used not for human use medication for humans. Like I am not unless you want to pay me a lot of money, I'm not taking that case on. So because it's all it comes back down to, you have to have good clinical judgment and sound clinical judgment and feel really confident in your decisions, which is why I am so. I am beyond passionate about the practice of law. I get really fired up about it. I put my hand up and swore an oath to protect the Constitution. And I will not let an outside business tell me that I can't represent my client the way that I need to represent my client. Now if my own board tells me that I can't do that, okay, sure, they control my license, I'll, I'll listen to them. But I can't imagine a, you know, Microsoft all of a sudden coming in and being like, no, you can't do that for your clients anymore. That's not. You're not allowed to represent them in that way. Like, this is my license and I'm going to represent them in the way that I see fit. And according to the board that governs my licensure in the court system, like, you have no say in this. And that is essentially what is going on here. Which is why I just really lean into like helping practices and providers protect that because we need. That's where we get into good medical judgment, good medical outcomes for clients so far beyond med spa world, like all the way down to hospitals. We don't want business to come in to medicine because that's when we can taint. You know, that's cynical, that's skeptical. But I have a license to do that. That's where business comes in and it can really, really mess with stuff because you're not. So often people stop thinking about what's best for the patient or thinking about the best treatments, and they are then going into like, what makes the most money or how do I profit out of this the most? And that's why we have so many laws and regulations, corporate practice and medicine clearly delineating the two. Because we want. And even for medicine, for law, there are other professions where we want to make sure that the in person who's the patient or the client or whoever, that we're protecting them from kind of that infiltration of business in a lot of ways.
- [48:25]
Daniela
This was so much incredible information. You are just brilliant, my dear. Thank you.
- [48:31]
Courtney
Thank you. I could go on and on. I mean, I have for months. It's like the number one thing what people want to talk about, but it's totally fine and I get it. And then I have people who. Because, you know, one of the things I said at the beginning is I want the best thing that someone could say to me is that they feel confident in their decision, whatever that decision is. So I want people to put their head down at night and maybe they get a letter down the road, but at least they're prepared, they know the risks. They've made a very calculated and intelligent decision for their business. And just giving them that confidence is like, I. I feel like truly that's one of my purposes in life is to help businesses navigate kind of a wild west, a gray area in medical aesthetics in so many ways. But there is a way to do it where you don't go to sleep every night being like, they're coming for me. They're probably not. But even if they do, we will have, like, I'm from Tennessee, so we will have a cheese board ready and some sweet tea and you'll be like, welcome party. Roll out the red carpet. Come in and see whatever you want.
- [49:47]
Daniela
Oh, my goodness. Okay, so where can people find you, follow you, stay in touch with you, get into your world. Where's the best place?
- [49:56]
Courtney
Yeah, I think the best place is on Instagram. For the most, like, live action content. It's court approved aesthetics. I do a segment that people really enjoy a lot. It's called Whiteboard Wednesday where I just put. Pull out a whiteboard and start. You've heard it here. Some like doing charts and really I'm a visual learner, so really breaking things down. Obviously, all that's for free. And I try to do like legal updates and stuff over on there. And then if anyone's ever interested in working with me, then it's Court approved aesthetics dot com.
- [50:32]
Daniela
Wonderful. Well, we'll get all of those links below this episode. I so appreciate you and your expertise and this was such an incredible episode. Be sure to check out Court approved aesthetics. And of course, if you want to keep this conversation going, head over to the Spa Marketing Made Easy Facebook group and I'll catch you on the next episode.